Smart About Meds (SAM): a pilot randomized controlled trial of a mobile application to improve medication adherence following hospital discharge

Bettina Habib, David Buckeridge, Melissa Bustillo, Santiago Nicolas Marquez, Manish Thakur, Thai Tran, Daniala L Weir, Robyn Tamblyn, Bettina Habib, David Buckeridge, Melissa Bustillo, Santiago Nicolas Marquez, Manish Thakur, Thai Tran, Daniala L Weir, Robyn Tamblyn

Abstract

Objective: The objectives of this pilot study were (1) to assess the feasibility of a larger evaluation of Smart About Meds (SAM), a patient-centered medication management mobile application, and (2) to evaluate SAM's potential to improve outcomes of interest, including adherence to medication changes made at hospital discharge and the occurrence of adverse events.

Materials and methods: We conducted a pilot randomized controlled trial among patients discharged from internal medicine units of an academic health center between June 2019 and March 2020. Block randomization was used to randomize patients to intervention (received access to SAM at discharge) or control (received usual care). Patients were followed for 30 days post-discharge, during which app use was recorded. Pharmacy claims data were used to measure adherence to medication changes made at discharge, and physician billing data were used to identify emergency department visits and hospital readmissions during follow-up.

Results: Forty-nine patients were eligible for inclusion in the study at hospital discharge (23 intervention, 26 control). In the 30 days of post-discharge, 15 (65.2%) intervention patients used the SAM app. During this period, intervention patients adhered to a larger proportion of medication changes (83.7%) than control patients (77.8%), including newly prescribed medications (72.7% vs 61.7%) and dose changes (90.9% vs 81.8%). A smaller proportion of intervention patients (8.7%) were readmitted to hospital during follow-up than control patients (15.4%).

Conclusion: The high uptake of SAM among intervention patients supports the feasibility of a larger trial. Results also suggest that SAM has the potential to enhance adherence to medication changes and reduce the risk of downstream adverse events. This hypothesis needs to be tested in a larger trial.

Trial registration: Clinicaltrials.gov, registration number NCT04676165.

Keywords: adverse events; medication adherence; mobile application; pilot randomized controlled trial.

© The Author(s) 2021. Published by Oxford University Press on behalf of the American Medical Informatics Association.

Figures

Figure 1.
Figure 1.
SAM main features. (A) List of prescribed and dispensed medications grouped by therapeutic class, with pill images and prescribed dosage. (B) Dropdown menu of one medication, showing buttons for an adherence alert, drug information leaflet, side effects, messaging feature, and Rate My Med feature. (C) Options to resolve an adherence alert. (D) Patient-friendly drug information leaflet. (E) List of side effects of one medication, with frequency of occurrence. (F) Pharmacist connect feature to send message to pharmacists. (G) Rate My Med feature. (H) Menu to access additional features. (I) Side effect profile of all of the user’s medications. (J) Medications associated with one of the side effects in the user’s side effect profile. (K) Search box for the interaction checker—user searches for medication they consider purchasing. (L) Interaction checker—displays interactions between medication selected in K and the user’s medication profile.
Figure 2.
Figure 2.
SAM pharmacist dashboard. (A) Main dashboard listing patients using the app who the pharmacist is currently managing. Patient information, hospital discharge site, hospital identification number (MRN), and medicare number (NAM) are displayed. New incoming messages from patients or caregivers are displayed, as are any unresolved notifications (i.e. adherence alerts). Through this dashboard, the pharmacist can also access the patient’s medication profile and documentation services. (B) Patient’s medication profile, with prescribed medications and dosage in the far left column, dispensed medications (if any) in the middle column along with dispensed strength, duration, quantity, and dispensing pharmacy, and any adherence alerts that require attention in the far right column.
Figure 3.
Figure 3.
CONSORT flow diagram.
Figure 4.
Figure 4.
Adherence to medication changes and adverse event rates, by treatment group.

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